Validation of a Textile-Based Wearable Measuring Electrocardiogram and Breathing Frequency for Sleep Apnea Monitoring.

Sleep apnea (SA) is a prevalent disorder characterized by recurrent events of nocturnal apnea. Polysomnography (PSG) represents the gold standard for SA diagnosis. This laboratory-based procedure is complex and costly, and less cumbersome wearable devices have been proposed for SA detection and monitoring. A novel textile multi-sensor monitoring belt recording electrocardiogram (ECG) and breathing frequency (BF) measured by thorax excursion was developed and tested in a sleep laboratory for validation purposes. The aim of the current study was to evaluate the diagnostic performance of ECG-derived heart rate variability and BF-derived breathing rate variability and their combination for the detection of sleep apnea in a population of patients with a suspicion of SA. Fifty-one patients with a suspicion of SA were recruited in the sleep laboratory of the Cantonal Hospital St. Gallen. Patients were equipped with the monitoring belt and underwent a single overnight laboratory-based PSG. In addition, some patients further tested the monitoring belt at home. The ECG and BF signals from the belt were compared to PSG signals using the Bland-Altman methodology. Heart rate and breathing rate variability analyses were performed. Features derived from these analyses were used to build a support vector machine (SVM) classifier for the prediction of SA severity. Model performance was assessed using receiver operating characteristics (ROC) curves. Patients included 35 males and 16 females with a median age of 49 years (range: 21 to 65) and a median apnea-hypopnea index (AHI) of 33 (IQR: 16 to 58). Belt-derived data provided ECG and BF signals with a low bias and in good agreement with PSG-derived signals. The combined ECG and BF signals improved the classification accuracy for SA (area under the ROC curve: 0.98; sensitivity and specificity greater than 90%) compared to single parameter classification based on either ECG or BF alone. This novel wearable device combining ECG and BF provided accurate signals in good agreement with the gold standard PSG. Due to its unobtrusive nature, it is potentially interesting for multi-night assessments and home-based patient follow-up.

Essential Oil Content, Composition and Free Radical Scavenging Activity from Different Plant Parts of Wild Sea Fennel (Crithmum maritimum L.) in Montenegro.

This study was conducted to determine the sea fennel essential oil (SFEO) yield, composition, and antioxidant activity of leaves, stem, inflorescences, and umbels from seeds of wild sea fennel (SF) (Crithmum maritimum L.) from the Montenegro coast. The chemical composition of isolated essential oil was determined by GC/MS and GC/FID analyses. The antioxidant activity was determined using the DPPH assay. The maximum SFEO yield was found in umbels with seeds (4.77 mL/100 g p.m.). The leaves contained less EO (0.52 mL/100 g p.m.) than immature inflorescence (0.83 mL/100 g p.m.) The minimum EO content was found in the stem (0.08%). Twenty components were isolated from SFEO leaves, twenty-four from inflorescence, thirty-four components from the stem, and twenty-one components from umbels with seeds. Limonene (62.4-72.0%), γ-terpinene (9.5-14.0%), α-pinene (1.4-5.8%), and sabinene (1-6.5%) were found to be the main components of the SFEO from monoterpene hydrocarbons as dominant grouped components (86% to 98.1%). SF plant parts showed differences in chemical profiles, especially in specific and low-represented ingredients. (E)-anethole (4.4%), fenchone (0.5%), and trans-carveol (0.2%) were present only in umbel with seeds, while the ß-longipipene (0.5%), (E)-caryophyllene (0.5%), and (2E)-decenal (0.2%) were found only in the stems. The degree of DPPH radical neutralization increased with incubation time. The SFEO isolated from the stems showed stronger antioxidant activity during the incubation times of 20 and 40 min (EC50 value of 5.30 mg/mL and 5.04 mg/mL, respectively) in comparison to the SFEO isolated from the other plant parts. The lowest antioxidant activity was obtained with the SFEO leaves (155.25 mg/mL and 58.30 mg/mL, respectively). This study indicates that SFEO possesses significant antioxidant activities and is animportant component in the food and pharmaceutical industries. It is important to preserve the existing gene pool and biodiversity with rational use SF for the extraction of high-quality essential oils.

Chemical Composition and Bioactivity of Dill Seed (Anethum graveolens L.) Essential Oil from Plants Grown under Shading.

This study determined the content and composition of dill seed (Anethum graveolens L.) essential oil under varying light conditions: non-shaded plants in open fields and plants covered with pearl shade nets (40% shade index). Essential oil was extracted using Clevenger hydrodistillation. The essential oil content was 4.63% for non-shaded plants and 4.81% for shaded plants. GC/MS analysis revealed twenty-one and twenty-two components in dill seed from non-shaded and shaded plants, respectively. The terpenic fraction of essential oil from non-shaded plants consisted mainly of oxygen-containing monoterpene derivatives (53.6%), with carvone (46.1%) as the primary component, followed by monoterpene hydrocarbons (46.4%), predominantly limonene (43.8%). Essential oil from shaded plants contained a higher content of carvone (49.8%) and a lower content of limonene (37.8%) compared to essential oil from non-shaded plants. Non-shaded plant essential oil exhibited stronger antioxidant activity (EC50 value: 26.04 mg mL-1) than shaded plant essential oil (54.23 mg mL-1). Dill seed essential oil showed the most potent antimicrobial activity (disc diffusion method) against Escherichia coli (inhibition zone: 15-18 mm). Shaded plants demonstrated a positive influence of essential oil against Klebsiella pneumoniae. Carvone and its derivatives, as the main components, hold significant potential in the food industry and alternative medicines. A practical implication of this study could be higher plant densities or intercropping of dill, as it thrives with minimal light.

Triplet-driven chemical reactivity of ß-carotene and its biological implications.

The endoperoxides of ß-carotene (ßCar-EPOs) are regarded as main products of the chemical deactivation of 1O2 by ß-carotene, one of the most important antioxidants, following a concerted singlet-singlet reaction. Here we challenge this view by showing that ßCar-EPOs are formed in the absence of 1O2 in a non-concerted triplet-triplet reaction: 3O2 + 3ß-carotene → ßCar-EPOs, in which 3ß-carotene manifests a strong biradical character. Thus, the reactivity of ß-carotene towards oxygen is governed by its excited triplet state. ßCar-EPOs, while being stable in the dark, are photochemically labile, and are a rare example of nonaromatic endoperoxides that release 1O2, again not in a concerted reaction. Their light-induced breakdown triggers an avalanche of free radicals, which accounts for the pro-oxidant activity of ß-carotene and the puzzling swap from its anti- to pro-oxidant features. Furthermore, we show that ßCar-EPOs, and carotenoids in general, weakly sensitize 1O2. These findings underlie the key role of the triplet state in determining the chemical and photophysical features of ß-carotene. They shake up the prevailing models of carotenoid photophysics, the anti-oxidant functioning of ß-carotene, and the role of 1O2 in chemical signaling in biological photosynthetic systems. ßCar-EPOs and their degradation products are not markers of 1O2 and oxidative stress but of the overproduction of extremely hazardous chlorophyll triplets in photosystems. Hence, the chemical signaling of overexcitation of the photosynthetic apparatus is based on a 3chlorophyll-3ß-carotene relay, rather than on extremely short-lived 1O2.

Perceval Sutureless Bioprosthesis for Degenerative Aortic Valve Stenosis: Initial Experience With 67 Patients.

OBJECTIVE: The objective of this prospective study was to evaluate the characteristics (positive and negative) of Perceval S valve in patients undergoing aortic valve replacement with a biological prosthesis. The study included 67 patients operated on at our institution and a mean follow-up period of 18 months. METHODS: From June 2016 to November 2019, 209 patients underwent aortic valve replacement with a biological prosthesis. Of these, 67 patients were included in the study based on the exclusion and inclusion criteria set before the study began. Their data were recorded during their hospital stay (preoperative, intraoperative, and early and late postoperative time). RESULTS: Fifty-four patients underwent isolated aortic valve replacement (group I) with a Perceval S prosthesis, and 13 patients had combined aortic valve replacement procedures and CABG procedures (group II). Patients were implanted with the following prosthesis sizes: S (N = 12), M (N = 18), L (N = 28), or XL (N = 9). The Perceval S valve successfully was implanted in 67 (91.8%) patients (in 6 patients, the preoperative transthoracic echocardiographic data did not coincide with intraoperative TEE and surgical measurement of the size of the annulus in the suture). Surgical approaches in patients were medial sternotomy (N = 48), mini sternotomy (N = 15), and thoracotomy through the second intercostal space to the right (N = 4). The mean clamping time of the aorta and CPB length for isolated cases was 54 and 82 minutes, respectively, and 96 and 120 minutes for combined procedures. Four (5.9%) patients died within 30 days. CONCLUSION: Early postoperative results showed that the Perceval S valve was safe. Further follow up is required to evaluate the long-term duration of patients with this bioprosthesis.

Modification of light intensity influence essential oils content, composition and antioxidant activity of thyme, marjoram and oregano.

Thymus vulgaris L. (thyme), Origanum majorana L. (marjoram), and Origanum vulgare L. (oregano) were used to determine whether light modification (plants grown under nets with 40% shaded index or in un-shaded open field) could improve the quantity and quality of essential oils (EOs) and antioxidant activity. The yield of EOs of thyme, marjoram, and oregano obtained after 120 min of hydrodistillation was 2.32, 1.51, and 0.27 mL/100 g of plant material, respectively. At the same time under shading conditions plants synthetized more EOs (2.57, 1.68, and 0.32 mL/100 g of plant material). GC/MS and GC/FID analyses were applied for essential oils determinations. The main components of the thyme essential oil are thymol (8.05-9.35%); γ-terpinene (3.49-4.04%); p-cymene (2.80-3.60%) and caryophyllene oxide (1.54-2.15%). Marjoram main components were terpinene 4-ol (7.44-7.63%), γ-terpinene (2.82-2.86%) and linalool (2.04-2.65%) while oregano essential oil consisted of the following components: caryophyllene oxide (3.1-1.93%); germacrene D (1.17-2.0%) and (E)-caryophyllene (1.48-1.1%). The essential oil from thyme grown under shading (EC50 value after 20 min of incubation) have shown the highest antioxidant activity - 0.85 mg mL-1 in comparison to marjoram and oregano (shaded plants EC50 19.97 mg mL-1 and 7.02 mg mL-1 and unshaded, control plants EC50 54.01 mg mL-1 and 7.45 mg mL-1, respectively). The medicinal plants are a good source of natural antioxidants with potential application in the food and pharmaceutical industries. For production practice, it can be recommended to grow medicinal plants in shading conditions to achieve optimal quality parameters.

[Outpatient Management of Primary Spontaneous Pneumothorax]. / Ambulantes Management des primären Spontanpneumothorax.

Outpatient Management of Primary Spontaneous Pneumothorax Abstract. Pneumothorax (PT) is defined as a collapse of the lung due to the collection of air in the pleural space. In primary spontaneous pneumothorax (PSP) there is no underlying pulmonary pathology. Treatment, either conservative or invasive, depends on the size of the PT, the patient's clinical situation and the patient's setting/environment. According to the actual literature, the uncomplicated PSP can at best be treated conservatively and on an outpatient basis. Management with intervention (needle aspiration or chest drainage) is historically carried out on an inpatient basis, but outpatient management (without comorbidities and without symptoms) is also possible. In these cases, the patient compliance (motivation, cognition, support, housing situation …) has to be proven. For outpatient management with intervention, a small-caliber chest tube (<14 F) with a Heimlich valve should be used.

Impact of people's behavior on the energy sustainability of the residential sector in emergency situations caused by COVID-19.

Humanity is currently confronted with a new, unknown, highly contagious virus, where social isolation and increased personal hygiene seem to be the main means in preventing its spread. The world economy is very threatened by the new situation, which has not bypassed the energy sector either. The mortality rate is relatively high, people are not leaving their homes, which is directly reflected in the increase of the energy consumption in the residential sector. The same is valid for water consumption. For a household located in Kragujevac (Central Serbia), 4 simulation scenarios were analyzed (S1 - reference case, S2 - mild protection measures, S3 - semi-quarantine measures, S4 - complete quarantine) to assess the link between people's behavior (on the one hand) and the consumption of natural gas, electricity and water (on the other hand), in the residential sector, in unforeseen circumstances, such as the COVID-19 virus pandemic. The analysis was conducted numerically for the month of March 2020, using EnergyPlus software packages. In defining the above scenarios, a one-minute time step schedule of people's behavior was used, taking into account the number of family members in the household, their age, occupation, lifestyle, habits (all in accordance with cultural and socio-economic circumstances), as well as the measures taken by the Government of the Republic of Serbia to fight the pandemic. Also, an analysis of energy consumption at the level of the city of Kragujevac for the past three years was made, based on data obtained from public companies - distributors (thermal energy, natural gas, electricity, water). In this paper, an analysis of air quality for the same time period was conducted, which is closely related to energy consumption and limited population movement. The simulatinos show that the consumption of natural gas can increase by 21.26% (S2), electricity by 58.39% (S4), and the consumption of water from the city water supply network by 25.45% (S3) compared to the reference case (S1). On the other hand, based on the invoice for payment of services to distributors, the actual energy consumption that was made on the analyzed house during the month of March 2020 was: natural gas (260.36 Sm3), electricity (1418 kWh), and water (22.5 m3). The conducted economic analysis showed that the largest funds at the level of the entire facility were allocated in S3 (27.33% more than in S1), and that the actual costs were 15.09% higher than in S1, and 16.41% lower than in S2.

Effect of shading and grafting on yield and quality of tomato.

BACKGROUND: The need to increase marketable tomato yields and decrease losses due to sunburn and disease during the summer motivates farmers to adopt additional cultural practices such as shading and grafting. To investigate complex interactions among grafting, shading, and tomato cultivar, grafted and ungrafted tomatoes (cv. 'Optima' F1 and cv. 'Big Beef' F1 ) were grown in the soil under net-house cover, using pearl and red nets, and in unshaded conditions (open fields). Tomato fruit at the red stage of maturity were used for the analysis of quality traits, and total and marketable yields were recorded during the whole production season. RESULTS: Grafting and shading in tomato production might be considered as cultivation practices to increase the marketable tomato yield. A decrease in sugar content increased the uptake of some micro elements (Fe and Zn) and macro elements (Ca). In some cases, firmer and less elastic skin may be expected due to grafting. Shading with pearl net might result in fruit with lower firmness and higher total, and particularly malic, acid content. CONCLUSION: Shading with colored nets and grafting provide alternative strategies for achieving higher fruit yields and avoiding or reducing a decrease in tomato quality caused by environmental stresses such as excessive radiation and temperature in the summer cropping season. © 2019 Society of Chemical Industry.

Off-Pump Plicating Ascending Aortoplasty With External Wrapping: Magnum in Parvo.

BACKGROUND: Isolated, fusiform aneurysms, exclusively affecting the tubular portion of the ascending aorta, are rare. Surgical treatment aims to change their natural course, reducing individual and cumulative risks of rupture, dissection and death. Open tubular graft replacement still remains the procedure of choice, despite significant risks. In permanent pursuit for optimal, alternative surgical strategy in high-risk patients, less invasive and off-pump plicating ascending aortoplasty with modified external Dacron graft wrapping seems to be a reliable choice. METHODS: Two (2) consecutive patients were operated on. The same preoperative calculations and slightly different operative techniques were applied regarding surgical exposure and wrapping graft orientation. Immediate and late follow-up (5 years) results were compared. RESULTS: Absolute and indexed target ascending aortic diameters remained acceptable (<2.1cm/m2 considered the upper normal range for adults). There were no significant changes in proximal and distal aortic diameters. Ascending aortic silhouette on contrast enhanced multi-detector CT was better with Dacron wrapping graft tailored to have its grooves in the longitudinal direction. Upper mini-sternotomy was quite appropriate for this procedure, from a surgical point of view, and was safe for the patient. CONCLUSIONS: Careful patient selection and using the current model of preoperative calculations and surgical technique resulted in acceptable and stable ascending aortoplasty in high-risk patients 5 years after surgery.

The estimation of the traditionally used yarrow (Achillea millefolium L. Asteraceae) oil extracts with anti-inflamatory potential in topical application.

ETHNOPHARMACOLOGICAL RELEVANCE: Olive or sunflower oil yarrow extracts have been extensively used against inflammatory disorders and skin wound healing in traditional medicine. AIM OF THE STUDY: To evaluate oil yarrow extracts traditional use in treatment of topical/dermatological skin impairments, sodium lauryl sulfate test was applied, and in vivo measuring of the biophysical parameters (erythema index, skin capacitance and the pH of the skin) in the artificially irritated skin was performed. As traditionally olive and sunflower oil have been used equally for extracts production, the experiment was carried out to investigate whether any of the oil extractants has the advantage over the other, and if the method of extraction might influence the desired activity. The observed activity has been connected to the chemical profile of the investigated extracts and their antioxidative properties. MATERIALS AND METHODS: In vivo measurements were performed using the appropriate probes for measuring skin capacitance, pH of the skin and erythema index (EI). The designed experiment enabled the evaluation of the anti-inflammatory effects of a seven-day application of oil yarrow extracts known in traditional medicine, on artificially irritated skin of volunteers. The chemical profile for the investigated samples was achieved applying the HPLC and UHPLC-MS methods. Also, ferric reducing antioxidant power (FRAP) test was performed to assess the antioxidant properties of the investigated samples. RESULTS: The application of tested oil extracts on artificially irritated skin in vivo demonstrated the ability to re-establish their optimal pH and hydration of skin to the values measured prior to the irritation. Considering the EI transition, the investigated samples succeeded in re-establishing the baseline values, with no significant difference after three- and seven-day application. CONCLUSIONS: The data obtained in the study showed that the oil yarrow extracts had an evident anti-inflammatory property. Namely, the investigated extracts demonstrated significant anti-inflammatory effect in an in vivo double blind randomized study, using a sodium lauryl sulfate test. The skin parameters assessed in the study (skin capacitance, pH and EI) were restored to the basal values after three- and seven-day treatment with the tested extracts. The shown effects were attributed to yarrow oil extracts composition. The yarrow oil extracts might be used as promising base in the phytopreparations designed for dermatological application as anti-inflammatory agents with a positive impact on the skin pH and its moisture content.

Measurement and evaluation of the environmental noise levels in the urban areas of the city of Nis (Serbia).

The environmental noise level represents one of the key factors of life quality in urban areas of modern cities. A continuous monitoring of the noise levels and the analysis of results have become a necessity when we discuss a possible recovery of those areas with high levels of noise pollution, and particularly, those zones which were designed for specific activities, e.g., areas around hospitals and schools. The city of Nis, Serbia, owing to the permanent long-term noise monitoring, possesses a database containing figures related to the noise levels at relevant locations in the city, which can serve as a basis for an analysis of the change of conditions, their tendencies in the future, and recognizing factors which influence the danger of noise pollution. The paper involves an analysis of the environmental noise level collected during the previous years.

Unusual forms of ruptured abdominal aortic aneurysms.

Over 95% of abdominal aortic aneurysms (AAAs) rupture into the retroperitoneal space. Rare types of AAA ruptures comprise ruptures into the inferior vena cava with aortocaval fistula formation (ACF), ruptures into the duodenum with formation of a primary aortoduodenal fistula (ADF), and chronic contained ruptures (CCRs). This article presents a study of 41 cases with unusual forms of ruptured AAA of a series of 506 patients with AAA rupture treated within a 14-year period. There were 11 cases of CCR, 5 cases with ADF, and 25 cases with ACF. The correct preoperative diagnosis was established in 6 (of 11) cases of CCR, in 2 (of 5) cases of primary ADF, and in 13 (of 25) cases of ACF. AAA replacement was performed in 8 cases using a tube graft, whereas a bifurcated graft was used in 31 patients because of the distant extent of the atherosclerotic/aneurysmatic lesions engaging iliac arteries. Two patients had an axillobifemoral bypass. The overall 30-day mortality rate was 19% (8 of 41), with subgroup mortality rates of 0 (CCR), 60% (ADF), and 20% (ACF). Diagnosis and treatment are simplest in cases of CCR and the most complicated in cases of ADF.

False anastomotic aneurysms.

This retrospective study covers the period from 1991 to 2002, during which 3,623 patients were operated on because of aneurysmal or occlusive disease of aortoiliac and femoropopliteal segments. Among them, 87 patients (2.4%) developed a false anastomotic aneurysm in the 12-year follow-up period and were treated operatively. Most frequently, in 53 patients (6.9%), a false anastomotic aneurysm developed after aortobifemoral bypass performed owing to aortoiliac occlusive disease. The cause of false anastomotic aneurysm was infection in 21 cases (24.7%); resection and revascularization were performed with a Dacron graft in 46 cases (52.9%), with a polytetrafluoroethylene graft in 10 cases (11.5%), and with the great saphenous vein in 16 cases (18.4%). Homograft implantation in 4 patients (4.6%) or extra-anatomic bypasses in 11 cases (12.6%) were performed when graft infection was suspected. Of 87 patients who underwent surgery, 74 (85.5%) had good early results without infection, reintervention, limb loss, and mortality. The presence of infection as a cause of false anastomotic aneurysm and comorbidity increased the mortality rate significantly after the reoperation, whereas the type of graft used in treatment had no influence on early results.